【原】醋酸盐与乳酸盐缓冲晶体溶液：Meta分析和试验序贯分析的系统评价

醋酸盐与乳酸盐缓冲晶体溶液：Meta分析和试验序贯分析的系统评价

贵州医科大学    麻醉与心脏电生理课题组

翻译：马艳燕  编辑：马艳燕  审校：曹莹

目的

在临床实践中广泛使用缓冲晶体溶液。然而，指南没有区分特定类型的缓冲溶液和临床平衡。本研究旨在评估醋酸盐与乳酸盐缓冲溶液对住院患者的益处和不良影响。

方法

我们进行了一项系统评估，对随机临床试验进行Meta分析和试验序贯分析，评估醋酸盐与乳酸盐缓冲溶液在住院成人和儿童患者中静脉内给药中的应用。主要结局指标是全因短期死亡率。我们遵守已公布的规程、系统回顾和Meta分析首选报告项目(PRISMA)声明、《Cochrane 手册》以及建议、评估、发展和评价(GRADE)方法的分级。

结果

本研究纳入五项随机对照试验，招募390名患者。我们发现，在醋酸盐缓冲溶液和乳酸盐缓冲溶液之间，短期死亡率(随机效应，RR＝0.29；95%CI 0.06-1.51，p=0.14， I2=0%)或住院时间(随机效应，D＝-1.31，95%CI 3.66-1.05，p=0.28，I2=0%)差异无统计学意义。证据质量非常低。三项试验报告了关于重症监护病房LOS的数据，一项试验报告了血管加压药治疗的持续时间;这些数据都不允许在meta分析中汇集。没有试验报告有关长期死亡率、健康相关生活质量、不良事件、机械通气持续时间或肾脏替代治疗的数据。

 结论：在这项系统性综述中，我们发现在住院患者中使用醋酸盐缓冲溶液与乳酸缓冲溶液的证据数量和质量都很低。

原始文献来源：Ellekjaer KL, Perner A, Sivapalan P, Møller MH. Acetate- versus lactate-buffered crystalloid solutions: A systematic review with meta-analysis and trial sequential analysis. Acta Anaesthesiol Scand. 2022;1‐13.

英文原文

Acetate- versus lactate-buffered crystalloid solutions: A systematic review with meta-analysis and trial sequential analysis

Objective: There is a widespread use of buffered crystalloid solutions in clinical practice. However, guidelines do not distinguish between specific types of buffered solutions and clinical equipoise exists. We aimed to assess the desirable and undesirable effects of acetate- versus lactate-buffered solutions in hospitalised patients. 

Methods: We conducted a systematic review with meta-analysis and trial sequential analysis of randomised clinical trials assessing the use of acetate- versus lactatebuffered solutions for intravenous administration in hospitalised adults and children. The primary outcome was all-cause short-term mortality. We adhered to our published protocol, the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement, the Cochrane Handbook and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology. 

Results: We included five RCTs enrolling 390 patients. We found no statistically significant difference in short-term mortality (random effects, risk ratio [RR] 0.29; 95% confidence interval [CI] 0.06–1.51, p = .14, I2 = 0%) or hospital length of stay (LOS) (random effects, mean difference [MD]—1.31, 95% CI  3.66 to 1.05, p = .28, I2 = 0%) between acetate- versus lactate-buffered solutions. The quality of evidence was very low. Data regarding intensive care unit LOS were reported by three trials and duration of vasopressor treatment by one trial; none of these data allowed for pooling in metaanalyses. No trials reported data on long-term mortality, health-related quality of life, adverse events, duration of mechanical ventilation or renal replacement therapy. 

Conclusion: In this systematic review, we found very low quantity and quality of evidence on the use of acetate- versus lactate-buffered solutions in hospitalised patients.

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